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FOR OFFICE USE ONLY MARION COUNTY BUILDING <br />Received by: 220 High Su'eet NE <br />Date: Salem, Oregon 97~301 <br /> Phone 588-5147 8;00 am - 4::30pa <br /> Code-A-Ph~ <br /> <br /> ELECTRICAL PERMIT APPLICATI(~,~ <br /> P/ease complete all Sections, 1 thro 5 <br /> <br />1- LOCATION OFINSTALLATION <br /> <br /> ~AR~ON COUN Y~ <br /> ...... ,, 't6t <br />BUILUW'~ '"" <br /> <br />pERMITS ARE; NON .'IRANSFEILABLE AND NON.REFUNDAE LE AND <br />EXPIRE IF WORK IS NOT STARTED WITHIN 180 DAYS OF ISSUANCE <br />OR JF WORK IS SUSPENDED FOR 1 S0 DAYS, <br /> <br />2A,, CONTRACYOR INSTALLATION ONLY <br /> <br />Property Ownct <br /> <br />· I Phone <br /> <br />$igl~atu~ of Supervising Electrician <br /> <br />2B, FOR OSVNER INS~rALLATIONS <br /> <br />Prol~rty Owner <br /> <br />Mailing AddrEss , Phone <br /> <br />City/St ateff,ip <br /> <br />3, PLAN REVIEW SECTION <br /> <br />We will provide plan review sctvicc if you complete Section <br />5B and submit two (2) sets of plans and specifications with <br />this application. <br /> <br />Thls optional plan review program does not suspend the <br />required submission of lighting power calculations, plans, <br />and specifications when required by the Oregon Stmctmal <br />Specialty Cede, Chapter 53. <br /> <br />MC 15-34 11/91 <br /> <br />Set <br /> <br />DwellL~g,g~t~ri~. or Fe. c0~t $4000 <br /> <br />$35 O0 <br /> <br />$5000 <br /> <br /> Installation, Alterations or Relocation <br /> 200 amps or less .. $5000 <br /> 201 amps m 400 ~unps ~ SOO,DO <br /> 401 amps tO 600 amp~ ~ $10000 <br /> eel amps m 1000 traps $~;30 00 <br /> Over 1000 anp~ or volt~ $~00 00 <br /> Reconnect only $40,00 <br /> <br />C. Temporary Services/Feeders <br />Instanatlon~ Alteratlon~ or Relocation <br />~ ~mps or less $35 00 <br />20t arnpa to 400 am~ ~O O0 <br />401 ammp~ s to 600 amps SB0,O0 <br />Over 600 amp~ or 1000 volts <br /> <br />D, Branch Cimui~ <br /> New, Altoratton, or Extension Per Panel <br /> <br /> a) The fee for branch <br /> pumhas¢ of se~riee or fe~er fee <br /> <br /> · Each branch clt~'oit $2 O0 <br /> b) Thc fee for branch clrcuts withou~ <br /> <br /> Each additional branch c/mult [ $2 O0 <br /> F~ch pump oc ungati~m circle $40,00 <br /> <br /> Pack of 10 labr& @ ~00 each <br /> (~otd o~0 to dec~r~,'at ¢or~mc~om) <br /> <br />FL Other <br /> <br />5__ <br />$ <br /> <br />5. FEES <br /> Al, EnmrtmaloffeeafromSec #4 <br /> AZ. Add 5% samharga (-05 x Al) <br /> <br /> Subtotal <br /> <br /> B, En~r 25% of Hne Al for Plan Ravie~ <br /> (Sec 3),, if required <br /> C InvcstigationFee (ff required) <br /> D Rcinspuctum Fee (525 0~) <br /> <br /> TOTAL AMOUNT DUE <br /> <br /> 2 <br />--2 <br />--2 <br /> 2 <br /> <br />__2 <br /> <br /> <br />